The Art of Choosing Wisely

Certain stories really raise my eyebrows. A patient recently told me about how he had seen three orthopedic surgeons who told him that he needed hip surgery for pain that began when he was chaperoning on a Boy Scout outing. He then saw a chiropractor who thought that his hip was slightly out of rotation and should respond to physical therapy. He chose the latter and, after the better part of a year, he is pain-free and “as active as a teenager” without surgery. Touché!

It’s Complicated

Coupla points here. The first is that not all doctors are the same. A corollary is that not all health care is the same. The second is that doctors often have a “tool chest” that they rely on to get the job done. It’s the “if you have a hammer then everything is a nail phenomenon. Surgeons like to operate. Chiropractors don’t do surgery, and so they offer alternatives that work for them. Although this may appear problematic, it can be a real plus for inquiring patients, like our man with hip pain.

Believe in You

So I encourage you to ask questions about your medical care. Get the answers you need to move forward and get better. My patient had good common sense and applied it to his problem until it was solved. It confirms the often quipped attribute that “patient’s know their bodies best.”
But let’s get more specific here. Take vasectomy reversal surgery, an out-of-pocket procedure that addresses a very important and often life-changing matter: building families. Although its part of healthcare, you should really think of it as a “commodity,” similar to (but probably more important than) say, buying a dishwasher or even a car. You have a good idea of how to buy things that you need in life, right? So why not approach this the same way?

Quality is #1

If you want to buy a quality product, begin with research. Go to trusted sources. Friends are one such source. Colleagues may be another. And don’t forget the World Wide Web. These are a great help in learning the reputation, ratings and reliability of surgeons. You can also find out if they have published their success rates, which is probably the most authentic measure of quality. Remember too, that like many things in this world, you get what you pay for. So cheaper isn’t always the best way to go if quality is what you seek.

Are You My Surgeon?

Once you’ve narrowed down the list of reversalists, go deep. Meet them or talk to them, and ask your questions:

  • Explain all of my options to me. Not just your favorite choices, but things that others may be doing. This is one way to earn patient trust; it’s also part of informed consent.
  • What are your personal success rates for patients like me? Hey, it’s the era of pay-for-performance, so show me some numbers!
  • How many cases do you do annually? As in many medical fields, there is a strong correlation between surgical volume and outcomes.
  • What are your complication rates? Hey, these are the family jewels we’re dealing with, so look me in the eye and tell me the truth!
  • What is your stenosis rate? (i.e. the chance that a sperm count obtained after the vasectomy reversal subsequently reverts to zero over time). If you draw a blank stare on this one, head for the door, as it should be <5%.
  • Where does the care begin…and end? Are you in for a wham-bam-one-day-stand with the surgeon or is there good follow-up care after the big event?

And use your gut. If the office staff seems unorganized, they probably are. If the surgeon appears distracted, they probably are. If the calls aren’t returned and the questions aren’t answered, there’s probably a good reason. Great medical care, just like a golf swing, requires follow through, and it begins with attention to details and great service. No different than what you’d expect when spending money to buy anything. This is less about being picky than staying true to yourself. In the words of Alice Walker: “The most common way people given up their power is by thinking they don’t have any. Remember, it’s your life, your health and your wallet that’s at stake.